Scoliosis

Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. When viewed from the side, the upper back has a normal roundback or kyphosis, while in the lower spine there is “swayback”, or lordosis. When viewed from behind, a spine normally appears straight but some people have spines that also curve from side to side and rotate. This condition of side-to-side spinal curvature is called scoliosis. Unlike poor posture, these curves can’t be corrected simply by learning to stand up straight. On an x-ray, the spine of a person with scoliosis looks more like an “S” or a “C” than a straight line. A slight curvature may be normal. Scoliosis is present when the spine has one or more abnormal curves of greater than 10°, as measured on the x-ray. 

In childhood, idiopathic scoliosis occurs in both girls and boys. However, as children enter adolescence, girls are five to eight times more likely to have their curves increase in size and require treatment.

WHAT CAUSES AIS?

Adolescent
Idiopathic Scoliosis (AIS) is a genetic condition, meaning it is
inherited and a family may have more than one member with the diagnosis.
The exact reason why the spine curves remains unknown (idiopathic). A
difference in the rate of growth between the front and back of the spine
is the leading theory.

SIGNS AND SYMPTOMS

Adolescent Idiopathic Scoliosis does not usually cause pain, neurological dysfunction such as weakness or numbness in the legs, or respiratory problems (shortness of breath). Most patients are highly functional and without any symptoms.

Most patients or parents note one or more of the following changes in the patient’s appearance:

• Chest shifted to one side
• Head not centered over bottom
• One shoulder blade more noticeable than the other (Fig 4) Unevenness of the waist
• Clothes hang unevenly
• One shoulder higher than the other
• One hip higher than the other 
• Unevenness of the front of the chest

CURVE PROGRESSION

Although we do not know the cause of idiopathic scoliosis, we do know that curves tend to progress based on two major factors: growth remaining in the spine and the curve size. Idiopathic scoliosis curves can get larger during growth of the spine especially during the rapid adolescent growth spurt. Age, the timing of the onset of menstrual periods in girls, the status of the growth plates of the pelvis and hand are all good predictors of how much spine growth is left. We can review these parameters to estimate the risk of curve progression in your child. Even after your child stops growing, a large curve can get worse. Generally, curves in the thoracic spine greater than 45 or 50 degrees and lumbar curves greater than 35 or 40 degrees will progress even into adulthood. When significant growth remains AND the curve is larger than these thresholds, curve progression is 100 percent.

What Kind of Non-Surgical Treatments Are Available? 

Depending on age, skeletal maturity, and curve size, scoliosis has traditionally been managed non-surgically with either a “wait and see” approach if curves are under 25 degrees, or bracing if curves are over 25 and the child has yet to reach full skeletal maturity.  More recently, PSSE (Physiotherapy Scoliosis Specific Exercises) have started to be recognized by the Scoliosis Research Society as an effective way to manage the effects of scoliosis during the “wait and see” period, and also during bracing.  These exercises are customized for each patient to return the curved spine to a more natural position.     

At our office located in Boise, we are the first to be certified in a Scoliosis Specific Exercise Program in the state of Idaho based on the principles of Katherina Schroth known as the “Schroth Method.”  Katharina Schroth (1894-1985) developed the Schroth Method, based on her personal experience with scoliosis as a teen. She dedicated countless hours attempting different corrections of her curve and discovered certain positions, movements and breathing techniques which made her own torso deformity less obvious. Trained as a teacher, Ms. Schroth started sharing her techniques with patients in the 1920’s and eventually established her own clinic in Germany. Her daughter, Christa Lehnert-Schroth P.T. (www.schroth-skoliosebehandlung.de and schrothmethod.com) helped her further develop the theory underlying the Schroth Method.  Over one thousand patients are treated annually at Asklepios Katharina-Schroth Klinic in Germany and there is frequently a several month long waiting list.  

WHAT ARE THE GOALS OF PSSE’s?

Since spine rotation in scoliosis is different in each person, Scoliosis Specific Exercises are tailored to your unique curvature of the spine, and include three important components:

Muscular Symmetry
The changes in the curvature of your spine also affect the muscles in your back. On one side of the back the muscles are tight and shortened. On the other side, the muscles are longer than usual.  In short, the muscles are imbalanced.  Scoliosis Specific Exercises (i.e. Schroth) are designed to address both problems, aiming to achieve muscular symmetry.

Rotational Angular Breathing
Breathing is an important part of the Schroth Method. The method uses a special breathing technique called rotational angular breathing. The idea is to reshape the rib cage and change the muscle imbalance promoting more equal forces on the spine.

Awareness of Your Posture
Being aware of the position of your spine is the first step to correcting it. Postural awareness is especially important when it comes to activities of daily living. If you have scoliosis, you will always need to be mindful of the positions that may make it worse.

What results can be expected after completing a Schroth program?

• Improved posture
• Improved core stability and strength
• Easier breathing
• Improved overall movement pattern and function
• Improved self-management and understanding of the spine
• Better pelvis alignment ***Depending on your age, bone maturity and the degree of curvature, bracing may also be a part of the treatment.

We work closely with orthotists and prosthetists in the Treasure Valley to help patients achieve the best possible results.  Schroth-specific breathing complements bracing as children are able to achieve a more balanced breathing pattern with bracing and exercise, and Schroth-specific exercises improve postural strength which may improve brace compliance and overall comfort.**

I AM AN ADULT WITH SCOLIOSIS. CAN PSSE’s HELP ME?

Yes!  As an adult, the goal is to address the musculature and soft tissue surrounding your curve.  Muscles on one side of the curve that are shortened can be lengthened, and muscles that are stretched and long on the other side of the curve can be shortened and strengthened using the principles of the Schroth Method to achieve a more balance spine and posture.  Call our office for more information to see if our exercise program is right for you.  

Kyphosis

 

Kyphosis is a term that describes increased rounding of the spine when viewed from the side. When kyphosis is increased, some people refer to it as a “round back” or “hunchback”. A normal spine has a straight appearance when viewed from the front or back, and several gentle curves when viewed from the side. The chest area has a normal rounding called thoracic kyphosis, while in the lower spine there is an opposite curve called lumbar lordosis. The two opposite curves of the spine work together to provide balance and an upright posture.

A normal thoracic spine consists of twelve vertebrae, each with two ribs, labeled T1-T12 (T for thoracic) from top to bottom. The natural, normal roundness of the thoracic spine can be measured by your doctor on an X-ray, and typically ranges from 10° to 45°. When the kyphosis of the thoracic spine increases past 45° it is called “hyperkyphosis”.

Patients with kyphosis often have poor posture and complain of back pain that can interfere with daily activities.  Increased kyphosis can be classified as either structural or non-structural.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is a type of structural kyphosis
that occurs in teenage years (ages 12 to 15 in boys or 10 to 14 in
girls) as a result of abnormal growth along the spine. The front
sections of the vertebrae grow slower than the back sections, producing
wedge-shaped vertebrae and a progressive increase in
kyphosis. Instead of normal, rectangular vertebrae with a smooth
kyphosis, wedge-shaped vertebrae exaggerate the forward bend of the
spine and cause increased kyphosis. This
abnormal, increased kyphosis is best viewed from the side with the
patient bending forward, attempting to touch their toes. A sharp,
angular hump is clearly visible. Most cases of Scheuermann’s kyphosis
that develop with growth remain mild and require only
periodic examinations with X-rays to monitor the condition.

Non-Operative Treatment

Like Scoliosis, non-surgical treatment depends on age, severity, and skeletal maturity.  Also like scoliosis,
patients are often told to “wait and see” or be recommended for bracing.

In our Boise office, we offer specialized exercises to help with kyphosis known as the “Schroth Method.” (See our Scoliosis page for more information on the history, details, and research supporting this method.) These exercises incorporate elongating the spine, breathing techniques, and core and postural strengthening.  Patient’s who participate in a Schroth-based exercise program often report increased control of spine, improved posture, and typically decreased pain.  Call our office for more details to see if this treatment is right for you or your child.